Use this template to prepare a Certificate and Indemnity with respect to a lost share certificate, to be given by a shareholder in a Canadian company.

The shareholder certifies that a certificate representing shares in the company issued in the shareholder's name is missing and requests a replacement certificate.

The shareholder indemnifies the company against any claims with respect to the loss and reissue of the share certificate. The form also includes a Resolution of the company, authorizing the issuance of a replacement certificate.

This Canada Certificate and Indemnity form is in MS Word format and can be easily edited.